CMS Releases 2013 Physician Fee Schedule and Announces 2013 SGR Cut

The Centers for Medicare and Medicaid Services (CMS) released their 2013 Physician Fee Schedule on November 1st. For lots of medical professionals, the new fee schedule may mean overhauling many of the ways their business will be conducted. With the new plan, CMS is looking deep into several things, with an overall goal of eliminating over payments to hospitals for patient care and improving the delivery of healthcare across the board. In order to avoid a negative audit, physicians should pay close attention to the new plan and make the necessary changes ahead of time.

Sustainable Growth Rate Formula

Starting on January 1, 2013, the Sustainable Growth Rate (SGR) cuts are targeted to be 26.5%. This will affect all services and the Conversion Factor (CF) will decrease from $34.0376 in CY 2012 to $25.0008 for CY 2013. Due to other announcements with this new fee schedule and other changes in code value, the amount of the payment adjustment for a specific code may be more or less than 26.5%.

Radiology Specific Adjustments

Radiology offices need to pay particular attention because they will be hit with additional adjustments for mis-valued codes on top of the SGR related cuts. For example, radiation oncology will see a -7% payment adjustment while interventional radiology, nuclear medicine and radiology will each see a -3% payment adjustment. Meanwhile, Radiation Therapy Centers are targeted for a -9% reimbursement SGR adjustment.

Geographic Practice Cost Indices

While the CMS has not yet released the details of the Geographic Practice Cost Indices (GPCI) for 2013, many anticipate that it will result in greater cuts to the Medicare physician fee schedule. It is expected that the increase will not exceed 1% for 2013. Malpractice cost components and practice expenses of every one of the 7,000 plus different types of physician services will be assigned individual GPCI.